potently hereditary. The other known causes of cirrhosis 

 of the liver are subsidiary, and need not here be considered. 

 Here then we have an affection, the three main causes of 

 which are indubitably subject to heredity, and however 

 diverse in their nature, yet tend to produce a well-known 

 disease of the liver ! Here we have an example of the 

 manifold and complex influences of heredity on the human 

 system in relation with its diseases, and it should always 

 be remembered that there are many cases in which, although 

 like cannot be said to produce like, yet the influence of 

 heredity is potent and effective. When alluding to cirrhosis 

 of the kidneys, I stated that it was frequently observed as 

 part of a constitutional condition characterised by fibrotic 

 changes in vessels and organs ; these observations are, 

 however, still sub judice, so I shall not insist upon their 

 accuracy, but I have, at least, shown that the causes of 

 cirrhosis of the liver are mainly heritable, and if so, I 

 cannot see why their effects should not be so also. If a 

 predisposition to allied pathological changes or conditions 

 is inherited, as it unquestionably is, I fail to recognise the 

 mode of reasoning which would exclude cirrhosis of the 

 liver or at least a predisposition from the same category. 

 Amyloid degeneration, whether of kidneys, liver, or other 

 organ, never appears as a primary affection, but as the result 

 of a pre-existing general cachexia, induced by various morbid 

 conditions usually associated with prolonged suppuration, 

 ulceration of bones and joints, also of soft parts (as in 

 empyema), or with chronic pulmonary phthisis, constitutional 

 syphilis, or other chronic constitutional diseases. Like most 

 other constitutional conditions, the cachexia, however in- 

 duced, may be transmitted, whether associated with amyloid 

 degeneration or not; and what is still more to the point, 



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